Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 2015018339 | MO |
NPI | 1023499118 |
---|---|
Provider Name | Dr. Patnakon Kevin Sonthana |
First Address | Lees Summit, MO 64081-3286 |
Second Address | Lees Summit, MO 64081-3286 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2015 |
Last Update Date | 15/06/2015 |